JOVE Application

	The information requested below is used to provide needed contact information, to determine your eligibility, to determine how best to serve you, and to ensure your entitlements are known to you. Contact Information Fields with an asterisk (*) are required.
Last Name (*)	Please type your last name.
First Name (*)	Enter your first name
MI	Invalid Input
Street	Invalid Input
City/Town (*)	Please enter City/Town
State (xx) (*)	Please enter state (xx)
Zip	Invalid Input
	Please enter at least one phone number below
Home Phone	Enter valid phone (123-456-7890)
Check if preferred daytime phone	Invalid Input
Cell Phone	Invalid Input
Check if preferred daytime phone	Invalid Input
Email (*)	Please enter a valid email address.
	Service Information
Branch of Service (*)	Please SelectArmyArmy (ARNG)MarinesNavyAir Force Air National GuardU.S. Coast Guard Please choose from the list
Years of Active Service (*)	Please enter numbers only.
Total Years of Service	Please enter numbers only.
	Separation Date (Final Discharge)
Separation date (yyyymmdd) (*)	Please enter separation date (yyyymmdd)
Military Medical Retiree	Invalid Input
Temporary Disability Retired List	Invalid Input
Type of Discharge (*)	Please SelectHonorableGeneral Other Pick from the list
Age (*)	Please enter numbers only.
Military Skill Speciality (include Alphanumeric Code if known).	Invalid Input
Period of Service	Please SelectGWOT/OEF/OIF EraBalkan Peacekeeping EraPersian Gulf War EraVietnam EraOther Invalid Input
Combat Theater Vet (Deployed)	Invalid Input
	VA Enrollment Information
Enrolled in Healthcare System	Invalid Input
Enrolled in 5 Year Combat Theater Vet Program	Invalid Input
Have VA Disability Compensation or Pension	Invalid Input
Have met with an accredited veterans service officer	Invalid Input
Have met with a VA vocational rehab & employment counselor	Invalid Input
Are using a vocational rehab and employment service program	Invalid Input
Enrolled in another disability program from state or federal government	Invalid Input
	CareerLink Information
Attended CareerLink's “Introduction to Services” session(s)	Invalid Input
Enrolled in CareerLink Job Club	Invalid Input
Have seen a CareerLink Veterans Employment Representative	Invalid Input
Rep Name (if remembered)	Invalid Input
Enrolled in another job program	Invalid Input
Completed another job program	Invalid Input
Last civilian position or job title	Invalid Input
Last civilian industry worked in	Invalid Input
Name of last employer's business	Invalid Input
Last employment date (yyyymmdd) (*)	Invalid Input
Years of employment there	Please enter numbers only.
	Qualifications
	Check up to 3 career categories for which you think you are qualified
Construction	Invalid Input
Electrical/Mechanical	Invalid Input
Manufacturing/Ops	Invalid Input
Government	Invalid Input
Administration	Invalid Input
Distribution	Invalid Input
Regulatory/Quality Control or Assurance	Invalid Input
Purchasing	Invalid Input
Retail	Invalid Input
IT/IS/Web/e-commerce	Invalid Input
Sales/Marketing/Business Development	Invalid Input
General Management/Executive	Invalid Input
	Education/Certifications Information
List educational institute and other career training; certificates and licenses	Invalid Input
	Other Information Please make a selection for the next two questions.
Will you help others by sharing job leads and by continuing to network after finding employment?	Please SelectYesNoMaybe Invalid Input
How did you first hear about JOVE?	Please SelectFlyer PosterNewspaperRadioTVMeetingVeterans Event EmailFriendSpouseParentWord of mouth Invalid Input
Additional Remarks	Invalid Input
AntiSpam (*)	Invalid Input
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	FOR JOVE COMMITTEE USE ONLY
CL Intro	Invalid Input
Member sign-in sheet	Invalid Input
Added to Database	Invalid Input
Added to Yahoo Groups	Invalid Input
New member info sent	Invalid Input
Coaching	Invalid Input
Profile and resume posted	Invalid Input
Change in status date	Invalid Input
Status change on sign-in sheet	Invalid Input
Exit from sent date	Invalid Input
Removed from Yahoo Groups	Invalid Input
Database updated	Invalid Input
P&R removed	Invalid Input
Remarks	Invalid Input